NYAC Parish Development Committee

New York Annual Conference

Mid-Range(Yellow Light) Missional Grant Application Form

This form is to be used to request funding for new and emerging ministries

in the range of $15,001 - $50,000

Part I(to be completed by church)

Church:______NYAC #______

District______Pastor______

Address______

Phone #______Church Email ______

Number of services per week ______Average Weekly Attendance (total)______

Brief description of the church’s congregation and immediate community: ______

______

Name / Title ofProgram Seeking Funding: ______

Explain the reasoningbehind the church's decision to implement this program: ______

______

Identify the Persons or Groups to be served by this program______

______

Purpose and goals of program (list all relevant aspects of the program including day/time, number of people needed to operate the program, material resources required, location in/out of the church, equipment needed and/or any improvements to be made to the facility)

______

Amount of funds requested from Parish Development $______

Amount of funds from the local congregation to be invested in the program $ ______

Other funders: Amount of funds from community groups or agencies (UM City Society, United Way,

EFAP, HIPNAP, Food Bank, etc.) $______

Provide detail of how Parish Development funds will be used (if a detailed budget of the program is

written, please attach):______

______

If this is a request for continuation of funds, please provide evidence of how previous funds were

expended: ______

______

Attach to this application:

Current yearchurch budget and proposed budget for the subsequent year

Church's Balance Sheet (Assets & Liabilities) and/or current Audit Report

By submitting this application, the church acknowledges that the final decision will be determined based upon the evidence of need / value as presented in said application, and the availability of funds. Further, the church also acknowledges that acceptance of this application and its accompanying funds are subject to quarterly review. The church agrees to provide evidence of the expenditures of said funds when notified by the Conference Office prior to the release of funds each quarter.

Submitted by:

______Date______

Pastor

______Date______

Administrative Council President

______Date______

Church Treasurer

Part II(to be filled out by District Committee of Parish Development)

Has church applying for funds been visited by Chair or member of the District Committee?

______Yes ____ No (If no, application will not be considered)

If yes, who visited church and when?

Name(s):______

Date: ______

Name of Church Representative met by Committee ______

Brief Description of the condition of the church and its facilities: ______

______

After visiting the church, examining its condition, and learning about the program, does the Committee believe this program should be funded? _____Yes _____ No

Explain reason for answer: ______

______

Submitted by:

Name / Title: ______

Date: ______

Part III (to be filled out by the Pastor)

Church seeking funds is in compliance for the past five years with:

Apportionments Past and Current: ____ Yes ____ No

Pastor’s Benefits: ____ Yes ____ No

Parish Development Loans outstanding (if applicable) ____ Yes ____ No

If any questions were answered NO, please explain the circumstances under which this application should be considered:

______

By signing and approving this application, I certify that the church seeking these funds to start / continue a ministry – mission program, has been deemed vital to making Disciples of Jesus Christ.

I am also assured that the funds given will not be used for any other purpose other than the program described herein.

Name: ______District ______

Date: ______

Part IV (to be filled out by the Dir. Congregational Development & Revitalization)

Church seeking funding is deemed a vital congregation based on the following criteria:

Is this an outwardly-focused ministry? ______
Are there any other outwardly-focused ministries? ______
Is this church engaged a “partner” in the community? ______
Is there a plan/is the congregation eager for engagement? ______
Has the congregation paid 100% apportionments? ______
Is there a plan/is the congregation eager to rise to 100%? ______
Does the DS support this ministry? ______

Recommendation: YES ______NO ______

Name: ______Date: ______

Part V(to be filled out by the Parish Development Committee)

Action taken by Committee - Approved____ Rejected____ Tabled_____

Amount of funds granted $______

Signed by ______Date ______

Title______

Note: Send completed application to your District Parish Development Chairperson